title: Marital quality and survivorship: slowed recovery for breast cancer patients in distressed relationships.
abstract: BACKGROUND
  Although marital distress has been implicated in difficulties with adjustment to a breast cancer diagnosis, its long-term effects, especially on physical recovery, are unknown.
  
  
  METHODS
  Longitudinal data from newly diagnosed breast cancer patients (N=100) who were married or cohabiting were used. Patients were assessed after diagnosis and surgery (baseline) and then reassessed every 4 or 6 months for the next 5 years. Women in stable, distressed relationships (n=28) were compared with those in stable, nondistressed relationships (n=72). Stress, health behavior, and health outcomes were examined using mixed-effects modeling.
  
  
  RESULTS
  Overall, marital distress was associated with slowed recovery trajectories and poor outcomes. At baseline, both groups had equivalent, high levels of stress, but diverged thereafter. Stress declined more slowly for the Distressed group, and by 5 years it remained significantly higher. Differential reductions in physical activity were also observed. With regard to health, the Distressed group was found to have a slower recovery in performance status and more symptoms/signs of illness and treatment side effects through 3 years. Finally, all the effects were observed above and beyond reductions occurring with depressive symptomatology, which was significantly higher in the Distressed group.
  
  
  CONCLUSIONS
  Marital distress is not only associated with worse psychologic outcomes for breast cancer survivors, but poorer health and a steeper decline in physical activity. These novel data demonstrate recovery trajectories for breast cancer survivors to be constrained for those also coping with ongoing difficulties in their marriage.
authors.affiliation: Department of Psychology, the Ohio State University, Columbus, Ohio 43210-1222, USA. yang.1043@osu.edu
authors.forename: Hae-Chung
authors.initials: HC
authors.lastname: Yang
authors.forename: Tammy A
authors.initials: TA
authors.lastname: Schuler
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000523:psychology*; D003863:Depression / Q000150:complications; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008393:Marriage; D008875:Middle Aged; D009043:Motor Activity; D013315:Stress, Psychological / Q000150:complications